AMNIOTIC FLUID EMBOLISM
Tuffnell DJ. Amniotic fluid embolism. Curr Opin ObstetGynecol 2003; 15:119-22.
Davies S. Amniotic fluid embolus: a review of the literature. Can J Anaesth. 2001; 48:88-98.
• Uncommon, but a leading cause of death of maternal death in the developed world
• True incidence unknown because of varying presentations; incidence ranges from 1:8,000 to 1:80,000 in
• Mortality rate used to be 86% (as recent as 1979), but with better recognition and ICU care, mortality
down to approximately 15%
• May be more common in older, multiparous women who experience prolonged, difficult labor
• Usually occurs during childbirth but has been described during pregnancy
• “Classic” presentation: dyspnea, cyanosis, arrhythmia, hypotension, hemorrhage, disseminated
intravascular coagulation, culminating in cardiovascular collapse; however, presentation may be more subtle.
• Maternal collapse usually occurs before fetal collapse, but vice-versa can occur and should trigger
investigation into this diagnosis
• Amniotic fluid embolism may be an anaphylaxis-like reaction.
• Serum tryptase levels are typically elevated and complement levels are usually low.
• However, amniotic fluid embolism is still a clinical diagnosis
• First resuscitate the patient.
• Second, perform prompt C-section.
• Third, consider uterine artery embolization, plasma exchange, and/or CVVH (all have been described,
but only in case reports).